Method of treating heart failure using leukemia inhibitory factor antagonists optionally with endothelin antagonists

ABSTRACT

A leukemia inhibitory factor antagonist, alone or in combination with an endothelin antagonist, may be used for treatment of heart failure. The antagonist(s) are administered in a chronic fashion, in therapeutically effective amounts, to achieve this purpose.

This is a continuation of co-pending application Ser. No. 08/428,002filed Apr. 24, 1995, U.S. Pat. No. 5,573,762, which application isincorporated herein by reference and to which application priority isclaimed under 35 USC §120.

BACKGROUND OF THE INVENTION

1. Field of the Invention

This application relates to a method for modulating cardiac function inthe treatment of heart disorders.

2. Background of the Invention

Heart failure affects approximately three million Americans, developingin about 400,000 each year. It is currently one of the leading admissiondiagnoses in the U.S. Recent advances in the management of acute cardiacdiseases, including acute myocardial infarction, are resulting in anexpanding patient population that will eventually develop chronic heartfailure.

Current therapy for heart failure is primarily directed to usingangiotensin-converting enzyme (ACE) inhibitors and diuretics. Whileprolonging survival in the setting of heart failure, ACE inhibitorsappear to slow the progression towards end-stage heart failure, andsubstantial numbers of patients on ACE inhibitors have functional classIII heart failure. Moreover, ACE inhibitors consistently appear unableto relieve symptoms in more than 60% of heart failure patients andreduce mortality of heart failure only by approximately 15-20%. Hearttransplantation is limited by the availability of donor hearts. Further,with the exception of digoxin, the chronic administration of positiveinotropic agents has not resulted in a useful drug without accompanyingadverse side effects, such as increased arrhythmogenesis, sudden death,or other deleterious side effects related to survival. Thesedeficiencies in current therapy suggest the need for additionaltherapeutic approaches.

A large body of data suggests that pathological hypertrophy of cardiacmuscle in the setting of heart failure can be deleterious, characterizedby dilation of the ventricular chamber, an increase in walltension/stress, an increase in the length vs. width of cardiac musclecells, and an accompanying decrease in cardiac performance and function.In fact, the effects of ACE inhibitors have been purported not only tounload the heart, but also to inhibit the pathological hypertrophicresponse that has been presumed to be linked to the localizedrenin-angiotensin system within the myocardium.

On a cellular level, the heart functions as a syncytium of myocytes andsurrounding support cells, called non-myocytes. While non-myocytes areprimarily fibroblast/mesenchymal cells, they also include endothelialand smooth muscle cells. Indeed, although myocytes make up most of theadult myocardial mass, they represent only about 30% of the total cellnumbers present in heart. Because of their close relationship withcardiac myocytes in vivo, non-myocytes are capable of influencingmyocyte growth and/or development. This interaction may be mediateddirectly through cell-cell contact or indirectly via production of aparacrine factor. Such association in vivo is important since bothnon-myocyte numbers and the extracellular matrix with which theyinteract are increased in myocardial hypertrophy and in response toinjury and infarction. These changes are associated with abnormalmyocardial function.

Cardiac myocytes are unable to divide shortly after birth. Furthergrowth occurs through hypertrophy of the individual cells. Cell culturemodels of myocyte hypertrophy have been developed to understand betterthe mechanisms for cardiac myocyte hypertrophy. Simpson et al., Circ.Res., 51: 787-801 (1982); Chien et al., FASEB J., 5: 3037-3046 (1991).Most studies of heart myocytes in culture are designed to minimizecontamination by non-myocytes. See, for example, Simpson and Savion,Cir. Cres., 50: 101-116 (1982); Libby, J. Mol. Cell. Cardiol., 16:803-811 (1984); Iwaki et al., J. Biol. Chem., 265: 13809-13817 (1990).

Hypertrophy of adult cardiac ventricular myocytes is a response to avariety of conditions which lead to chronic overload. This response ischaracterized by an increase in myocyte cell size and contractileprotein content without concomitant cell division, and activation ofembryonic genes, including the gene for atrial natriuretic peptide(ANP). Chien et al., supra. Adult myocyte hypertrophy is initiallybeneficial as a short term response to impaired cardiac function bypermitting a decrease in the load on individual muscle fibers. Withsevere, long-standing overload, however, the hypertrophied cells beginto deteriorate and die. Katz, "Heart failure," in Katz AM, ed.,Physiology of the Heart (New York: Raven Press; 1992) pp. 638-668.

Endothelial cells, smooth muscle cells and fibroblast/mesenchymal cellsexist in close contact with myocytes in the heart. Nag, Cytobios., 28:41-61 (1980). In vitro studies have indicated that paracrine factorsproduced by these "non-myocyte" supporting cells may be involved in thedevelopment of hypertrophy. The identification of such factors remains amajor pursuit in cardiac biology and medicine. Chien et al., Science,260: 916-917 (1993). See also Chien et al., Annu. Rev. Physiol., S5:77-95. (1993), regarding the use of an in vitro assay system formyocardial cell hypertrophy to isolate and characterize novel activitiesthat might mediate this important physiological response.

Cell culture models have been developed to study hypertrophy and itscauses. Thus, for example, totipotent mouse embryonic stem cellsdifferentiate into multicellular, cystic embryoid bodies when culturedin the absence of a fibroblast feeder layer or with the removal ofleukemia inhibitory factor (LIF). Robbins et al., J. Biol. Chem., 265:11905-11909 (1990). Since these embryoid bodies spontaneously beat anddisplay cardiac- specific markers (Robbins et al., supra; Doetschman etal., J. Embryol. Exp. Morphol., 87: 27-45 1985!; Miller-Hance et al., J.Biol. Chem., 268: 25244-25252 1993!), they might serve as a valuablesource of factors that can induce a hypertrophic response in vitro.Chien, Science, supra; Miller-Hance et al., supra.

Further, Long et al., Cell Reg., 2: 1081-1095 (1991), discovered thatcultured neonatal rat cardiac non-myocytes, which were primarilyfibroblast-like cells, produced an unidentified protein that alsoinduced hypertrophy of cardiac myocytes in vitro. This factor bound toheparin-sepharose, failed to stimulate phosphoinositol hydrolysis, andhad an apparent molecular weight of 45 to 50 kD. Experiments withneutralizing antisera to platelet-derived growth factor, tumor necrosisfactor alpha, acidic and basic fibroblast growth factors andtransforming growth factor beta 1, eliminated these growth factors aspossible candidates.

Endothelin has been shown to affect the cells in the heart both in vivoand in vitro. In vivo endothelin is present in both atrial andventricular myocardium in healthy and failing hearts and enhancesmyocardial inotropic activity, vascular smooth muscle proliferation andcoronary vasoconstriction. Wei et al., Circulation, 89: 1580-1586(1994). In vitro endothelin stimulates multiple cell-signalling pathwaysin cultured adult cardiac myocytes. Hilal-Dandan et al., Mol. Pharm.,45: 1183-1190 (1994); Jones et al., Am. J. Physiol.(Heart Circ. Physiol.32) 263: H1447-H1454 1992). Several investigators have shown thatendothelin-1, which is known to be produced in endothelial cells,induces hypertrophy of cardiac myocytes in vitro. Shubeita et al., J.Biol. Chem., 265: 20555-20562 (1990); Ito et al., Circ Res., 69: 209-215(1991); Suzuki et al., J. Cardiovasc. Pharmacol., 17 Suppl 7: S182-S186(1991). See also U.S. Pat. No. 5,344,644 issued Sep. 6 1994.

LIF, also known as leukocyte inhibitory factor, differentiation-inducingfactor (DIF, D-factor), hepatocyte-stimulating factor (HSF-II HSF-III),and melanoma-derived LPL inhibitor (MLPLI), depending on its particularactivity or effect (Hilton et al., J. Cell. Biochem., 46: 21-26 1991!),has also been identified as the cholinergic neuronal differentiationfactor (CDF) from rat neonatal heart cell cultures with both myocytesand non-myocytes. Yammamori et al., Science, 246: 1412-1416 (1989).Additionally, LIF has been found to be useful for the protection,inhibition, and prevention of the deleterious effects of reactive oxygenspecies, including myocardial infarcts and protection of ischemictissues. U.S. Pat. No. 5,370,870. Finally, LIF and cardiotrophin-1(CT-1), another member of the family of proteins that bind toGH/cytokine receptors, show the most potent hypertrophy activity of thatfamily of proteins on neonatal rat cardiac myocytes in culture, and theyalso induce a similar morphology. Pennica et al., Proc. Natl. Acad. Sci.USA, 92: 1142-1146 (1995).

SUMMARY OF THE INVENTION

It has now been shown herein that non-myocytes produce hypertrophicfactors that are identified as LIF and endothelin. Accordingly, theinvention provides, in one aspect, a method for treating a mammalexperiencing heart failure to prevent or lessen hypertrophy comprisingadministering chronically to a mammal in need of such treatment atherapeutically effective amount of a LIF antagonist.

In another aspect, the invention provides a method for treating a mammalexperiencing heart failure to prevent or lessen hypertrophy comprisingadministering chronically to a mammal in need of such treatment atherapeutically effective amount of a LIF antagonist and an endothelinantagonist.

In a still further aspect, the invention provides a compositioncomprising a LIF antagonist and an endothelin antagonist in apharmaceutically acceptable carrier.

BRIEF DESCRIPTION OF THE DRAWINGS

FIG. 1 discloses the effect of non-myocyte-conditioned medium (NCM) fromrat neonates on cultured rat neonatal cardiac myocyte size, expressed ashypertrophy score, and ANP production. Myocytes were treated with NCMfor 48 hours. The culture medium was assayed for ANP (FIG. 1B), and thecells were stained with crystal violet and scored for hypertrophy (FIG.1A). Untreated controls were scored as 3 and maximally hypertrophiedcells as 7. The data represent the mean and standard error of threeexperiments done in duplicate and assayed in duplicate.

FIG. 2 discloses the time course of appearance of hypertrophy activityin rat neonatal cardiac NCM. Passage-one rat neonatal cardiacnon-myocytes were cultured in 10% serum containing medium for 5 days,then washed twice in serum-free medium. Assay medium was added andaliquots were removed after culture for the times indicated. The datarepresent the mean and standard error of three experiments done induplicate and assayed in duplicate.

FIG. 3 shows the effect of BQ-123, LIF monoclonal antibody (Mab) D62.3.2and their combination on myocyte hypertrophy induced by rat neonatalcardiac NCM. Myocytes were treated with NCM (solid circles), NCM and 100μmol/L BQ-123 (open circles), NCM and 50 μg/mL LIF Mab D62.3.2 (opensquares) NCM and 100 μmol/L BQ-123 and 50 μg/mL LIF Mab D62.3.2 (opentriangles). The culture medium was assayed for ANP (FIG. 3B) and thecells were stained and scored for hypertrophy (FIG. 3A). The data inFIG. 3A represent the mean and standard error of three experiments donein duplicate and assayed in duplicate. *p value<0.05 by analysis ofco-variance. The data in FIG. 3B represent one experiment done intriplicate and assayed in duplicate.

FIGS. 4A-4D depict the effect of BQ-123 on cardiac myocyte hypertrophyinduced by endothelin-1, mouse LIF, phenylephrine, and CT-1. Culturedrat neonatal cardiac myocytes were treated with BQ-123 at 0 μmol/L(solid circles), 100 μmol/L (open circles), 10 μmol/L (open squares),and 1 μmol/L (open triangles) in the presence of endothelin-1 (FIG. 4A),mouse LIF (FIG. 4B), phenylephrine (FIG. 4C), and CT-1 (FIG. 4D). Thedata represent the mean and standard error of three experiments done induplicate and assayed in duplicate.

FIGS. 5A-5D depict the effect of LIF Mab D62.3.2 on cardiac myocytehypertrophy induced by endothelin-1, mouse LIF, phenylephrine, and CT-1.Cultured neonatal rat cardiac myocytes were treated with LIF Mab D62.3.2at 0 μg/mL (solid circles), 50 μg/mL (open circles), 5 μg/mL (opensquares), and 0.5 μg/mL (open triangles) in the presence of endothelin-1(FIG. 5A) , mouse LIF (FIG. 5B), phenylephrine (FIG. 5C), and CT-1 (FIG.5D). The data represent the mean and standard error of three experimentsdone in duplicate and assayed in duplicate.

FIG. 6 depicts the effect of LIF and endothelin on cultured neonatal ratcardiac myocyte hypertrophy and ANP production. Myocytes were treatedwith mouse LIF (open circles), endothelin-1 (solid circles), and acombination of mouse LIF and endothelin-1 (solid triangles). The assaymedium was assayed for ANP (FIG. 6A) and the myocytes were stained withcrystal violet and scored for cell size (FIG. 6B). The data representthe mean and standard error of three experiments done in duplicate andassayed in duplicate. The concentration of the combination of LIF andendothelin was determined by adding the concentrations of each agent.

DETAILED DESCRIPTION OF THE PREFERRED EMBODIMENTS

I. Definitions

In general, the following words or phrases have the indicated definitionwhen used in the description, examples, and claims:

"LIF antagonist" and "endothelin antagonist" as used herein mean anymolecule which blocks or prevents the interaction between LIF orendothelin and their respective receptors. Such antagonists accomplishthis effect in various ways. For instance, one class of antagonists willbind to LIF or endothelin with sufficient affinity and specificity toneutralize LIF or endothelin such that they have no effect on theirrespective receptors. Included within this group of antagonists areantibodies. Another class of antagonists are molecules based on aninteraction between the LIF or endothelin and their respectivereceptors. Such molecules include fragments of the LIF or endothelinreceptor or small bioorganic molecules, e.g. peptidomimetics, that willprevent the interaction between the respective receptor and the LIF orendothelin. LIF is described by, e.g., Metcalf, Growth Factors, 7:169-173 (1992) and Kurzrock et al., Endocrine Reviews, 12: 208-217(1991). Activation of the LIF receptor has been shown to stimulateintracellular tyrosine kinases. Kishimoto et al., Science, 258:593-597(1992). Several laboratories have shown that fibroblasts in culture canproduce LIF (Elias et al., Am. J. Physiol. (Lung Cell. Mol. Physiol.10). 266: L426-L435 1994!; Lorenzo et al., Clin. Immunol. Immunopath.,70: 260-265 1994!; Hamilton et al. J. Immunol., 150: 1496-1502 1993!).

There are three endothelin-related peptides, endothelin-1, -2, and -3.Inoue et al., Proc. Natl. Acad. Sci. USA, 86: 2863-2867 (1989).Endothelin-1 is a 21 amino acid peptide which is a potent venous andarterial vasoconstrictor. The mature biologically active peptide is aproteolytic product of the 38-39 amino acid molecule "Big Endothelin."Yanagisawa and Masaki, Trends Pharm. Sci., 10: 374-378 (1989).Endothelin has been shown to induce protein tyrosine phosphorylation inaortic smooth muscle cells, mesangial cells, and osteoblast-like cells(Battistini et al., Peptides, 14: 385-399 1993!), but in neonatal ratmyocytes in culture, endothelin, like the alpha adrenergic agents,stimulates phosphoinositide hydrolysis and the accumulation ofdiacylglycerol. Shubeita et al., supra, and Ito et al., supra.Endothelins are produced by vascular endothelial cells, epithelialcells, macrophages, fibroblasts and many other types of cells.Battistini et al., supra.

The antagonists to these molecules influence cardiac growth orhypertrophy activity, as measured, e.g., by atrial natriuretic peptide(ANP) release or by the myocyte hypertrophy assay described herein usinga specific plating medium and plating density, and preferably usingcrystal violet stain for readout. The desired function of an antagonistis to provide the result desired in the continuum of equilibria betweengrowing and shrinking of cardiac muscle tissue.

Non-limiting examples of LIF antagonists include antibodies, proteins,peptides, glycoproteins, glycopeptides, glycolipids, polysaccharides,oligosaccharides, nucleic acids, bioorganic molecules, peptidomimetics,pharmacological agents and their metabolites, transcriptional andtranslation control sequences, and the like. Another class ofantagonists blocks or prevents intracellular or membrane associatedevents occurring between the respective receptor and the LIF orendothelin.

In a preferred embodiment the antagonist is an antibody, which antibodyhas the desirable properties of binding to LIF or endothelin andpreventing its interaction with its respective receptor. Such antibodiesare preferably generated against recombinant human LIF that areneutralizing against the hypertrophy induced by both human and mouseLIF, but not against CT-1-, endothelin-, or phenylephrine-inducedhypertrophy. For example, in the example below, three monoclonalantibodies meeting these criteria were identified, each of whichrecognizes a different antigenic determinant on recombinant human LIF.All three of these antibodies neutralized the myocyte hypertrophyinduced by mouse and human LIF and two of them were equipotent ininhibiting the hypertrophy induced by NCM. One or more of theseantibodies are described in WO 93/23556 published 25 Nov. 1993; Kim etal., J. Immunol. Meth., 156: 9-17 (1992); and Alphonso et al., J.Leukocyte Biology (Abstracts of the 28th National Meeting of the Societyfor Leukocyte Biology, vol. 0, no. SP.2 (1991) (NY, N.Y., p. 49) (MabsD4.16.9, D25.1.4, and D62.3.2).

In another preferred aspect, the antagonist is a soluble receptor basedon the primary structure of the endothelin or LIF receptor which has thedesirable quality of preventing the interaction of the respectivereceptor with the LIF or endothelin. In another preferred embodiment,the antagonist is a bioorganic molecule, usually an orally activecompound that is based on molecular modeling studies, which is capableof preventing the interaction between the LIF or endothelin and itsrespective receptor. In another aspect of the invention, the antagonistis a transcriptional regulator of LIF or endothelin expression in vivo.

Non-limiting examples of endothelin antagonists include antagonistsagainst any type of endothelin, including endothelin-1, -2, and -3, bigendothelin, or combinations thereof. Such antagonists include not onlyantibodies, but also peptides that are selective blockers of endothelinA or endothelin B receptor or both. As pointed out above, the endothelinA receptor is selective for endothelin-1 and endothelin-2 overendothelin-3. The endothelin B receptor binds all three with the sameaffinity. One example is BQ-123 (Ihara et al., Life Science, 50: 247-2501992!; JP 51-94254A published Aug. 3, 1993; Webb et al., Biochem.Biophys. Res. Comm., 185: 887-892 1992!), a cyclic pentapeptide that isa potent and specific blocker of endothelin A receptors and blocks onlythe hypertrophic activity induced by endothelin-1, not CT-1, mouse LIF,or phenylephrine. Another example is the parent compound to BQ-123described by Ihara et al., Biochim. Biophys. Res. Comm., 178: 132-137(1991). Further examples include those described in EP 647,236; EP647,449; EP 633,259 (phenyl-sulfonyl amino-pyrimidine derivatives); EP601,386 (sulfonamide compounds); U.S. Pat. No. 5,292,740(phenylsulfonamidopyrimidines);and U.S. Pat. No. 5,270,313(phenyl-sulfonyl-aminopyrimidinederivatives).

"Antibodies" (Abs) and "immunoglobulins" (Igs) are glycoproteins havingthe same structural characteristics. While antibodies exhibit bindingspecificity to a specific antigen, immunoglobulins include bothantibodies and other antibody-like molecules which lack antigenspecificity. Polypeptides of the latter kind are, for example, producedat low levels by the lymph system and at increased levels by myelomas.

"Native antibodies and immunoglobulins" are usually heterotetramericglycoproteins of about 150,000.daltons, composed of two identical light(L) chains and two identical heavy (H) chains. Each light chain islinked to a heavy chain by one covalent disulfide bond, while the numberof disulfide linkages varies between the heavy chains of differentimmunoglobulin isotypes. Each heavy and light chain also has regularlyspaced intrachain disulfide bridges. Each heavy chain has at one end avariable domain (V_(H)) followed by a number of constant domains. Eachlight chain has a variable domain at one end (V_(L)) and a constantdomain at its other end; the constant domain of the light chain isaligned with the first constant domain of the heavy chain, and the lightchain variable domain is aligned with the variable domain of the heavychain. Particular amino acid residues are believed to form an interfacebetween the light- and heavy-chain variable domains (Clothia et al., J.Mol. Biol., 186: 651-663 1985!; Novotny and Haber, Proc. Natl. Acad.Sci. USA, 82: 4592-4596 1985!).

The term "variable" refers to the fact that certain portions of thevariable domains differ extensively in sequence among antibodies and areused in the binding and specificity of each particular antibody for itsparticular antigen. However, the variability is not evenly distributedthroughout the variable domains of antibodies. It is concentrated inthree segments called complementarity-determining regions (CDRs) orhypervariable regions both in the light-chain and the heavy-chainvariable domains. The more highly conserved portions of variable domainsare called the framework (FR). The variable domains of native heavy andlight chains each comprise four FR regions, largely adopting a β-sheetconfiguration, connected by three CDRs, which form loops connecting, andin some cases forming part of, the β-sheet structure. The CDRs in eachchain are held together in close proximity by the FR regions and, withthe CDRs from the other chain, contribute to the formation of theantigen-binding site of antibodies (see Kabat et al., Sequences ofProteins of Immunological Interest, Fifth Edition, National Institute ofHealth, Bethesda, Md. 1991!). The constant domains are not involveddirectly in binding an antibody to an antigen, but exhibit variouseffector functions, such as participation of the antibody inantibody-dependent cellular toxicity.

Papain digestion of antibodies produces two identical antigen- bindingfragments, called "Fab" fragments, each with a single antigen-bindingsite, and a residual "Fc" fragment, whose name reflects its ability tocrystallize readily. Pepsin treatment yields an F(ab')₂ fragment thathas two antigen-combining sites and is still capable of cross-linkingantigen.

"Fv" is the minimum antibody fragment which contains a completeantigen-recognition and -binding site. This region consists of a dimerof one heavy- and one light-chain variable domain in tight, non-covalentassociation. It is in this configuration that the three CDRs of eachvariable domain interact to define an antigen-binding site on thesurface of the V_(H) -V_(L) dimer. Collectively, the six CDRs conferantigen-binding specificity to the antibody. However, even a singlevariable domain (or half of an Fv comprising only three CDRs specificfor an antigen) has the ability to recognize and bind antigen, althoughat a lower affinity than the entire binding site.

The Fab fragment also contains the constant domain of the light chainand the first constant domain (CH1) of the heavy chain. Fab' fragmentsdiffer from Fab fragments by the addition of a few residues at thecarboxy terminus of the heavy chain CH1 domain including one or morecysteines from the antibody hinge region. Fab'-SH is the designationherein for Fab' in which the cysteine residue(s) of the constant domainsbear a free thiol group. F(ab')₂ antibody fragments originally wereproduced as pairs of Fab' fragments which have hinge cysteines betweenthem. Other chemical couplings of antibody fragments are also known.

The "light chains" of antibodies (immunoglobulins) from any vertebratespecies can be assigned to one of two clearly distinct types, calledkappa (κ) and lambda (λ), based on the amino acid sequences of theirconstant domains.

Depending on the amino acid sequence of the constant domain of theirheavy chains, immunoglobulins can be assigned to different classes.There are five major classes of immunoglobulins: IgA, IgD, IgE, IgG, andIgM, and several of these may be further divided into subclasses(isotypes), e.g., IgG-1, IgG-2, IgG-3, IgG-4, IgA-1, and IgA-2. Theheavy-chain constant domains that correspond to the different classes ofimmunoglobulins are called ;α, δ, ε, γ, and μ, respectively. The subunitstructures and three-dimensional configurations of different classes ofimmunoglobulins are well known.

The term "antibody" is used in the broadest sense and specificallycovers single monoclonal antibodies (including agonist and antagonistantibodies) and antibody compositions with polyepitopic specificity.

The term "monoclonal antibody" as used herein refers to an antibodyobtained from a population of substantially homogeneous antibodies,i.e., the individual antibodies comprising the population are identicalexcept for possible naturally occurring mutations that may be present inminor amounts. Monoclonal antibodies are highly specific, being directedagainst a single antigenic site. Furthermore, in contrast toconventional (polyclonal) antibody preparations which typically includedifferent antibodies directed against different determinants (epitopes),each monoclonal antibody is directed against a single determinant on theantigen. In addition to their specificity, the monoclonal antibodies areadvantageous in that they are synthesized by the hybridoma culture,uncontaminated by other immunoglobulins.

The monoclonal antibodies herein include hybrid and recombinantantibodies produced by splicing a variable (including hypervariable)domain of an anti-LIF or anti-endothelin antibody with a constant domain(e.g. "humanized" antibodies), or a light chain with a heavy chain, or achain from one species with a chain from another species, or fusionswith heterologous proteins, regardless of species of origin orimmunoglobulin class or subclass designation, as well as antibodyfragments (e.g., Fab, F(ab')₂, and Fv), so long as they exhibit thedesired biological activity. See, e.g., Cabilly et al., U.S. Pat. No.4,816,567; Mage and Lamoyi, in Monoclonal Antibody Production Techniquesand Applications, pp.79-97 (Marcel Dekker, Inc., New York, 1987).!

Thus, the modifier "monoclonal" indicates the character of the antibodyas being obtained from a substantially homogeneous population ofantibodies, and is not to be construed as requiring production of theantibody by any particular method. For example, the monoclonalantibodies to be used in accordance with the present invention may bemade by the hybridoma method first described by Kohler and Milstein,Nature, 256: 495 (1975), or may be made by recombinant DNA methods(cabilly et al., supra).

The monoclonal antibodies herein specifically include "chimeric"antibodies (immunoglobulins) in which a portion of the heavy and/orlight chain is identical with or homologous to corresponding sequencesin antibodies derived from a particular species or belonging to aparticular antibody class or subclass, while the remainder of thechain(s) is identical with or homologous to corresponding sequences inantibodies derived from another species or belonging to another antibodyclass or subclass, as well as fragments of such antibodies, so long asthey exhibit the desired biological activity (Cabilly et al., supra;Morrison et al., Proc. Natl. Acad. Sci. USA, 81: 6851-6855 1984!).

"Humanized" forms of non-human (e.g., murine) antibodies are specificchimeric immunoglobulins, immunoglobulin chains or fragments thereof(such as Fv, Fab, Fab', F(ab')₂, or other antigen-binding subsequencesof antibodies) which contain minimal sequence derived from non-humanimmunoglobulin. For the most part, humanized antibodies are humanimmunoglobulins (recipient antibody) in which residues from acomplementary-determining region (CDR) of the recipient are replaced byresidues from a CDR of a non-human species (donor antibody) such asmouse, rat, or rabbit having the desired specificity, affinity, andcapacity. In some instances, Fv framework residues of the humanimmunoglobulin are replaced by corresponding non-human residues.Furthermore, humanized antibodies may comprise residues which are foundneither in the recipient antibody nor in the imported CDR or frameworksequences. These modifications are made to further refine and optimizeantibody performance. In general, the humanized antibody will comprisesubstantially all of at least one, and typically two, variable domains,in which all or substantially all of the CDR regions correspond to thoseof a non-human immunoglobulin and all or substantially all of the FRregions are those of a human immunoglobulin consensus sequence. Thehumanized antibody optimally also will comprise at least a portion of animmunoglobulin constant region (Fc), typically that of a humanimmunoglobulin. For further details see: Jones et al., Nature, 321:522-525 (1986); Reichmann et al., Nature, 332: 323-329 (1988); andPresta, Curr. Op. Struct. Biol., 2: 593-596 (1992).

"Non-immunogenic in a human" means that upon contacting the polypeptidein a pharmaceutically acceptable carrier and in a therapeuticallyeffective amount with the appropriate tissue of a human, no state ofsensitivity or resistance to the polypeptide is demonstrable upon thesecond administration of the polypeptide after an appropriate latentperiod (e.g., 8 to 14 days).

"Heart failure" refers to an abnormality of cardiac function where theheart does not pump blood at the rate needed for the requirements ofmetabolizing tissues. The heart failure can be caused by any number offactors, including ischemic, congenital, rheumatic, or idiopathic forms.

"Treatment" refers to both therapeutic treatment and prophylactic orpreventative measures, wherein the object is to prevent or slow down(lessen) hypertrophy. Those in need of treatment include those alreadywith the disorder as well as those prone to have the disorder or thosein which the disorder is to be prevented. The hypertrophy may be fromany cause, including idiopathic, candiotrophic, or myotrophic causes, oras a result of ischemia or ischemic insults such as myocardialinfarction. Typically, the treatment is performed to stop or slow theprogression of hypertrophy, especially after heart damage, such as fromischemia, has occurred. Preferably, for treatment of myocardialinfarctions, the agent(s) is given immediately after the myocardialinfarction, to prevent or lessen hypertrophy.

"Chronic" administration refers to administration of the agent(s) in acontinuous mode as opposed to an acute mode, so as to maintain theinitial anti-hypertrophic effect for an extended period of time.

"Mammal" for purposes of treatment refers to any animal classified as amammal, including humans, domestic and farm animals, and zoo, sports, orpet animals, such as dogs, horses, cats, cows, etc. Preferably, themammal herein is human.

As used herein, "ACE inhibitor" refers to angiotensin-converting enzymeinhibiting drugs which prevent the conversion of angiotensin I toangiotensin II. The ACE inhibitors may be beneficial in congestive heartfailure by reducing systemic vascular resistance and relievingcirculatory congestion. The ACE inhibitors include but are not limitedto those designated by the trademarks Accupril® (quinapril), Altace®0(ramipril), Capoten® (captopril), Lotensine® (benazepril), Monopril®(fosinopril), Prinivil® (lisinopril), Vasotec® (enalapril), and Zestril®(lisinopril). One example of an ACE inhibitor is that sold under thetrademark Capoten®. Generically referred to as captopril, this ACEinhibitor is designated chemically as 1-(2S)-3-mercapto-2-methylpropionyl!-L-proline.

II. Modes for Practicing the Invention

The invention constitutes a method for treating a mammal having heartfailure, wherein a therapeutically effective amount of a LIF antagonistis chronically administered to the mammal. Optionally, the LIFantagonist is chronically administered in combination with an effectiveamount of an antagonist to endothelin. Additional optional componentsinclude a cardiotrophin inhibitor such as a CT-1 antagonist, an ACEinhibitor, such as captopril, and/or human growth hormone and/or IGF-Iin the case of congestive heart failure, or with anotheranti-hypertrophic or myocardiotrophic factor in the case of other typesof heart failure or cardiac disorder.

1. Preparation and Identification of Antagonists

A. General Preparation

Antagonists to LIF and endothelin can be prepared by using the predictedfamily of receptors for endothelin or for LIF. The endothelin A receptoris selective for endothelin-1 and endothelin-2 over endothelin 3. Theendothelin B receptor binds all three with the same affinity. Arai etal., Nature, 348: 730-735 (1990). LIF, as well as ciliary neurotrophicfactor (CNTF), interleukin-6 (IL-6), interleukin-11 (IL-11), CT-1, andoncostatin M (OSM), use related receptor signaling proteins includingGP130 that are members of the GH/cytokine receptor family. Kishimoto etal., Cell, 76: 253-262 (1994); Kitamura et al., Trends Endocrinol.Metab., 5: 8-14 (1994); Davis and Yancopoulos, Curr. Opin. Cell Biol.,5: 281-285 (1993); Pennica et al., supra.

The receptors for LIF and endothelin can be expression cloned from theirrespective families; then a soluble form of the receptor is made byidentifying the extracellular domain and excising the transmembranedomain therefrom. The soluble form of the receptor can then be used asan antagonist, or the receptor can be used to screen for small moleculesthat would antagonize LIF or endothelin activity, respectively.

Alternatively, variants of native LIF or endothelin are made that act asantagonists. The receptor binding site(s) of LIF and endothelin can bedetermined by binding studies and one or more of them eliminated bystandard techniques (deletion or radical substitution of appropriatenucleic acids) so that the molecule acts as an antagonist. Antagonistactivity can be determined by several means, including the hypertrophyassay described herein.

B. Antibody Preparation

(i) Starting Materials and Methods

Immunoglobulins (Ig) and certain variants thereof are known and manyhave been prepared in recombinant cell culture. For example, see U.S.Pat. No. 4,745,055; EP 256,654; EP 120,694; EP 125,023; EP 255,694; EP266,663; WO 88/03559; Faulkner et al., Nature, 298: 286 (1982);Morrison, J. Immun., 123: 793 (1979); Koehler et al., Proc. Natl. Acad.Sci. USA, 77: 2197 (1980); Raso et al., Cancer Res., 41: 2073 (1981);Morrison et al., Ann. Rev. Immunol., 2: 239 (1984); Morrison, Science,229: 1202 (1985); and Morrison et al., Proc. Natl. Acad. Sci. USA, 81:6851 (1984). Reassorted immunoglobulin chains are also known. See, forexample, U.S. Pat. No. 4,444,878; WO 88/03565; and EP 68,763 andreferences cited therein. The immunoglobulin moiety in the chimeras ofthe present invention may be obtained from IgG-1, IgG-2, IgG-3, or IgG-4subtypes, IgA, IgE, IgD, or IgM, but preferably from IgG-1 or IgG-3.

(ii) Polyclonal antibodies

Polyclonal antibodies to LIF or endothelin are generally raised inanimals by multiple subcutaneous (sc) or intraperitoneal (ip) injectionsof LIF or endothelin and an adjuvant. It may be useful to conjugate LIFor endothelin or a fragment containing the target amino acid sequence toa protein that is immunogenic in the species to be immunized, e.g.,keyhole limpet hemocyanin, serum albumin, bovine thyroglobulin, orsoybean trypsin inhibitor using a bifunctional or derivatizing agent,for example, maleimidobenzoyl sulfosuccinimide ester (conjugationthrough cysteine residues), N-hydroxysuccinimide (through lysineresidues), glutaraldehyde, succinic anhydride, SOCl₂, or R¹ N═C═NR,where R and R¹ are different alkyl groups.

Animals are immunized against the LIF or endothelin polypeptide orfragment, immunogenic conjugates, or derivatives by combining 1 mg or 1μg of the peptide or conjugate (for rabbits or mice, respectively) with3 volumes of Freund's complete adjuvant and injecting the solutionintradermally at multiple sites. One month later the animals are boostedwith 1/5 to 1/10 the original amount of peptide or conjugate in Freund'scomplete adjuvant by subcutaneous injection at multiple sites. Seven to14 days later the animals are bled and the serum is assayed for antibodytiter to LIF or endothelin or a fragment thereof. Animals are boosteduntil the titer plateaus. Preferably, the animal is boosted with theconjugate of the same LIF or endothelin or fragment thereof, butconjugated to a different protein and/or through a differentcross-linking reagent. Conjugates also can be made in recombinant cellculture as protein fusions. Also, aggregating agents such as alum aresuitably used to enhance the immune response.

(iii) Monoclonal antibodies

Monoclonal antibodies are obtained from a population of substantiallyhomogeneous antibodies, i.e., the individual antibodies comprising thepopulation are identical except for possible naturally occurringmutations that may be present in minor amounts. Thus, the modifier"monoclonal" indicates the character of the antibody as not being amixture of discrete antibodies.

For example, monoclonal antibodies using for practicing this inventionmay be made using the hybridoma method first described by Kohler andMilstein, Nature, 256: 495 (1975), or may be made by recombinant DNAmethods (Cabilly et al., supra).

In the hybridoma method, a mouse or other appropriate host animal, suchas a hamster, is immunized as hereinabove described to elicitlymphocytes that produce or are capable of producing antibodies thatwill specifically bind to the LIF or endothelin or fragment thereof usedfor immunization. Alternatively, lymphocytes may be immunized in vitro.Lymphocytes then are fused with myeloma cells using a suitable fusingagent, such as polyethylene glycol, to form a hybridoma cell (Goding,Monoclonal Antibodies: Principles and Practice, pp.59-103 AcademicPress, 1986!).

The hybridoma cells thus prepared are seeded and grown in a suitableculture medium that preferably contains one or more substances thatinhibit the growth or survival of the unfused, parental myeloma cells.For example, if the parental myeloma cells lack the enzyme hypoxanthineguanine phosphoribosyl transferase (HGPRT or HPRT), the culture mediumfor the hybridomas typically will include hypoxanthine, aminopterin, andthymidine (HAT medium), which substances prevent the growth ofHGPRT-deficient cells.

Preferred myeloma cells are those that fuse efficiently, support stablehigh-level production of antibody by the selected antibody-producingcells, and are sensitive to a medium such as HAT medium. Among these,preferred myeloma cell lines are murine myeloma lines, such as thosederived from MOPC-21 and MPC-11 mouse tumors available from the SalkInstitute Cell Distribution Center, San Diego, Calif. USA, and SP-2cells available from the American Type Culture Collection, Rockville,Md. USA.

Culture medium in which hybridoma cells are growing is assayed forproduction of monoclonal antibodies directed against LIF or endothelin.Preferably, the binding specificity of monoclonal antibodies produced byhybridoma cells is determined by immunoprecipitation or by an in vitrobinding assay, such as radioimmunoassay (RIA) or enzyme-linkedimmunoabsorbent assay (ELISA).

The binding affinity of the monoclonal antibody can, for example, bedetermined by the Scatchard analysis of Munson and Pollard, Anal.Biochem., 107: 220 (1980).

After hybridoma cells are identified that produce antibodies of thedesired specificity, affinity, and/or activity, the clones may besubcloned by limiting dilution procedures and grown by standard methods(Goding, supra). Suitable culture media for this purpose include, forexample, D-MEM or RPMI-1640 medium. In addition, the hybridoma cells maybe grown in vivo as ascites tumors in an animal.

The monoclonal antibodies secreted by the subclones are suitablyseparated from the culture medium, ascites fluid, or serum byconventional immunoglobulin purification procedures such as, forexample, protein A-Sepharose, hydroxyapatite chromatography, gelelectrophoresis, dialysis, or affinity chromatography.

DNA encoding the monoclonal antibodies of the invention is readilyisolated and sequenced using conventional procedures (e.g., by usingoligonucleotide probes that are capable of binding specifically to genesencoding the heavy and light chains of murine antibodies). The hybridomacells of the invention serve as a preferred source of such DNA. Onceisolated, the DNA may be placed into expression vectors, which are thentransfected into host cells such as E. coli cells, simian COS cells,Chinese hamster ovary (CHO) cells, or myeloma cells that do nototherwise produce immunoglobulin protein, to obtain the synthesis ofmonoclonal antibodies in the recombinant host cells. Review articles onrecombinant expression in bacteria of DNA encoding the antibody includeSkerra et al., Curr. Opinion in Immunol., 5: 256-262 (1993) andPluckthun, Immunol. Revs., 130: 151-188 (1992).

The DNA also may be modified, for example, by substituting the codingsequence for human heavy- and light-chain constant domains in place ofthe homologous murine sequences (Morrison, et al., Proc. Natl. Acad.Sci. USA, 81: 6851 1984!), or by covalently joining to theimmunoglobulin coding sequence all or part of the coding sequence for anon-immunoglobulin polypeptide. In that manner, "chimeric" or "hybrid"antibodies are prepared that have the binding specificity of an anti-LIFor anti-endothelin monoclonal antibody herein.

Typically such non-immunoglobulin polypeptides are substituted for theconstant domains of an antibody of the invention, or they aresubstituted for the variable domains of one antigen-combining site of anantibody of the invention to create a chimeric bivalent antibodycomprising one antigen-combining site having specificity for a LIF orendothelin and another antigen-combining site having specificity for adifferent antigen.

Chimeric or hybrid antibodies also may be prepared in vitro using knownmethods in synthetic protein chemistry, including those involvingcrosslinking agents. For example, immunotoxins may be constructed usinga disulfide-exchange reaction or by forming a thioether bond. Examplesof suitable reagents for this purpose include iminothiolate andmethyl-4-mercaptobutyrimidate.

(iv) Humanized antibodies

Methods for humanizing non-human antibodies are well known in the art.Generally, a humanized antibody has one or more amino acid residuesintroduced into it from a source which is non-human. These non-humanamino acid residues are often referred to as "import" residues, whichare typically taken from an "import" variable domain. Humanization canbe essentially performed following the method of Winter and co-workers(Jones et al., Nature 321, 522-525 1986!; Riechmann et al., Nature 332,323-327 1988!; Verhoeyen et al., Science 239, 1534-1536 (1988!), bysubstituting rodent CDRs or CDR sequences for the correspondingsequences of a human antibody. Accordingly, such "humanized" antibodiesare chimeric antibodies (Cabilly et al., supra), wherein substantiallyless than an intact human variable domain has been substituted by thecorresponding sequence from a non-human species. In practice, humanizedantibodies are typically human antibodies in which some CDR residues andpossibly some FR residues are substituted by residues from analogoussites in rodent antibodies.

The choice of human variable domains, both light and heavy, to be usedin making the humanized antibodies is very important to reduceantigenicity. According to the so-called "best-fit" method, the sequenceof the variable domain of a rodent antibody is screened against theentire library of known human variable-domain sequences. The humansequence which is closest to that of the rodent is then accepted as thehuman framework (FR) for the humanized antibody (Sims et al., J.Immunol., 151: 2296 1993!; Chothia and Lesk, J. Mol. Biol., 196: 9011987!). Another method uses a particular framework derived from theconsensus sequence of all human antibodies of a particular subgroup oflight or heavy chains. The same framework may be used for severaldifferent humanized antibodies (Carter et al., Proc. Natl. Acad. Sci.USA, 89: 4285 1992!; Presta et al., J. Immnol., 151: 2623 1993!).

It is further important that antibodies be humanized with retention ofhigh affinity for the antigen and other favorable biological properties.To achieve this goal, according to a preferred method, humanizedantibodies are prepared by a process of analysis of the parentalsequences and various conceptual humanized products usingthree-dimensional models of the parental and humanized sequences.Three-dimensional immunoglobulin models are commonly available and arefamiliar to those skilled in the art. Computer programs are availablewhich illustrate and display probable three-dimensional conformationalstructures of selected candidate immunoglobulin sequences. Inspection ofthese displays permits analysis of the likely role of the residues inthe functioning of the candidate immunoglobulin sequence, i.e., theanalysis of residues that influence the ability of the candidateimmunoglobulin to bind its antigen. In this way, FR residues can beselected and combined from the consensus and import sequences so thatthe desired antibody characteristic, such as increased affinity for thetarget antigen(s), is achieved. In general, the CDR residues aredirectly and most substantially involved in influencing antigen binding.

(v) Human antibodies

Human monoclonal antibodies can be made by the hybridoma method. Humanmyeloma and mouse-human heteromyeloma cell lines for the production ofhuman monoclonal antibodies have been described, for example, by Kozbor,J. Immunol. 133, 3001 (1984); Brodeur, et al., Monoclonal AntibodyProduction Techniques and Applications, pp.51-63 (Marcel Dekker, Inc.,New York, 1987); and Boerner et al., J. Immunol., 147: 86-95 (1991).

It is now possible to produce transgenic animals (e.g., mice) that arecapable, upon immunization, of producing a full repertoire of humanantibodies in the absence of endogenous immunoglobulin production. Forexample, it has been described that the homozygous deletion of theantibody heavy-chain joining region (J_(H)) gene in chimeric andgerm-line mutant mice results in complete inhibition of endogenousantibody production. Transfer of the human germ-line immunoglobulin genearray in such germ-line mutant mice will result in the production ofhuman antibodies upon antigen challenge. See, e.g., Jakobovits et al.,Proc. Natl. Acad. Sci. USA, 90: 2551 (1993); Jakobovits et al., Nature,362: 255-258 (1993); Bruggermann et al., Year in Immuno., 7: 33 (1993).

Alternatively, the phage display technology (McCafferty et al., Nature,348: 552-553 1990!) can be used to produce human antibodies and antibodyfragments in vitro, from immunoglobulin variable (V) domain generepertoires from non-immunized donors. According to this technique,antibody V domain genes are cloned in-frame into either a major or minorcoat protein gene of a filamentous bacteriophage, 'such as M13 or fd,and displayed as functional antibody fragments on the surface of thephage particle. Because the filamentous particle contains asingle-stranded DNA copy of the phage genome, selections based on thefunctional properties of the antibody also result in selection of thegene encoding the antibody exhibiting those properties. Thus, the phagemimics some of the properties of the B-cell. Phage display can beperformed in a variety of formats; for their review see, e.g., Johnsonand Chiswell, Curr. Op. Struct. Biol., 3: 564-571 (1993). Severalsources of V-gene segments can be used for phage display. Clackson etal., Nature, 352: 624-628 (1991) isolated a diverse array ofanti-oxazolone antibodies from a small random combinatorial library of Vgenes derived from the spleens of immunized mice. A repertoire of Vgenes from non-immunized human donors can be constructed and antibodiesto a diverse array of antigens (including self-antigens) can be isolatedessentially following the techniques described by Marks et al., J. Mol.Biol., 222: 581-597 (1991), or Griffith et al., EMBO J., 12: 725-734(1993).

In a natural immune response, antibody genes accumulate mutations at ahigh rate (somatic hypermutation). Some of the changes introduced willconfer higher affinity, and B cells displaying high-affinity surfaceimmunoglobulin are preferentially replicated and differentiated duringsubsequent antigen challenge. This natural process can be mimicked byemploying the technique known as "chain shuffling" (Marks et al.,Bio/Technology, 10: 779-783 1992!). In this method, the affinity of"primary" human antibodies obtained by phage display can be improved bysequentially replacing the heavy and light chain V region genes withrepertoires of naturally occurring variants (repertoires) of V domaingenes obtained from non-immunized donors. This technique allows theproduction of antibodies and antibody fragments with affinities in thenM range. A strategy for making very large phage antibody repertoireshas been described by Waterhouse et al., Nucl. Acids Res., 21: 2265-2266(1993).

Gene shuffling can also be used to derive human antibodies from rodentantibodies, where the human antibody has similar affinities andspecificities to the starting rodent antibody. According to this method,which is also referred to as "epitope imprinting", the heavy or lightchain V domain gene of rodent antibodies obtained by phage displaytechnique is replaced with a repertoire of human V domain genes,creating rodent-human chimeras. Selection on antigen results inisolation of human variable capable of restoring a functionalantigen-binding site, i.e. , the epitope governs (imprints) the choiceof partner. When the process is repeated in order to replace theremaining rodent V domain, a human antibody is obtained (see PCT WO93/06213, published 1 Apr. 1993). Unlike traditional humanization ofrodent antibodies by CDR grafting, this technique provides completelyhuman antibodies, which have no framework or CDR residues of rodentorigin.

(vi) Bispecific Antibodies

Bispecific antibodies are monoclonal, preferably human or humanized,antibodies that have binding specificities for at least two differentantigens. In the present case, one of the binding specificities is for aLIF, the other one is for an endothelin. Methods for making bispecificantibodies are known in the art.

Traditionally, the recombinant production of bispecific antibodies isbased on the co-expression of two immunoglobulin heavy chain-light chainpairs, where the two heavy chains have different specificities (Milsteinand Cuello, Nature, 305: 537-539 1983!). Because of the randomassortment of immunoglobulin heavy and light chains, these hybridomas(quadromas) produce a potential mixture of 10 different antibodymolecules, of which only one has the correct bispecific structure. Thepurification of the correct molecule, which is usually done by affinitychromatography steps, is rather cumbersome, and the product yields arelow. Similar procedures are disclosed in WO 93/08829 published 13 May1993, and in Traunecker et al., EMBO J., 10: 3655-3659 (1991).

According to a different and more preferred approach, antibody-variabledomains with the desired binding specificities (antibody-antigencombining sites) are fused to immunoglobulin constant-domain sequences.The fusion preferably is with an immunoglobulin heavy-chain constantdomain, comprising at least part of the hinge, CH2, and CH3 regions. Itis preferred to have the first heavy-chain constant region (CH1),containing the site necessary for light-chain binding, present in atleast one of the fusions. DNAs encoding the immunoglobulin heavy chainfusions and, if desired, the immunoglobulin light chain, are insertedinto separate expression vectors, and are co-transfected into a suitablehost organism. This provides for great flexibility in adjusting themutual proportions of the three polypeptide fragments in embodimentswhen unequal ratios of the three polypeptide chains used in theconstruction provide the optimum yields. It is, however, possible toinsert the coding sequences for two or all three polypeptide chains inone expression vector when the production of at least two polypeptidechains in equal ratios results in high yields or when the ratios are ofno particular significance. In a preferred embodiment of this approach,the bispecific antibodies are composed of a hybrid immunoglobulin heavychain with a first binding specificity in one arm, and a hybridimmunoglobulin heavy chain-light chain pair (providing a second bindingspecificity) in the other arm. It was found that this asymmetricstructure facilitates the separation of the desired bispecific compoundfrom unwanted immunoglobulin chain combinations, as the presence of animmunoglobulin light chain in only one half of the bispecific moleculeprovides for a facile way of separation.

For further details of generating bispecific antibodies, see, forexample, Suresh et al., Methods in Enzymology, 121: 210 (1986).

(vii) Heteroconjugate Antibodies

Heteroconjugate antibodies are also within the scope of the presentinvention. Heteroconjugate antibodies are composed of two covalentlyjoined antibodies. Such antibodies have, for example, been proposed totarget immune system cells to unwanted cells (U.S. Pat. No. 4,676,980),and for treatment of HIV infection (WO 91/00360; WO 92/00373; and EP03089). Heteroconjugate antibodies may be made using any convenientcross-linking methods. Suitable cross-linking agents are well known inthe art, and are disclosed in U.S. Pat. No. 4,676,980, along with anumber of cross-linking techniques.

C. Purification of Antagonists

Techniques used for separating the antagonist(s) from impurities dependon which particular antagonist(s) is being employed. These proceduresmay include, for example, one or more steps selected from immunoaffinitychromatography, ion-exchange column fractionation (e.g., on DEAE ormatrices containing carboxymethyl or sulfopropyl groups), chromatographyon Blue-Sepharose, CM Blue-Sepharose, MONO-Q, MONO-S, lentillectin-Sepharose, WGA-Sepharose, Con A-Sepharose, Ether Toyopearl, ButylToyopearl, Phenyl Toyopearl, or protein A Sepharose, SDS-PAGEchromatography, silica chromatography, chromatofocusing, reverse phaseHPLC (e.g., silica gel with appended aliphatic groups), gel filtrationusing, e.g., Sephadex molecular sieve or size-exclusion chromatography,chromatography on columns that selectively bind the LIF antagonist orendothelin antagonist, and ethanol or ammonium sulfate precipitation. Aprotease inhibitor may be included in any of the foregoing steps toinhibit proteolysis. Examples of suitable protease inhibitors includephenylmethylsulfonyl fluoride (PMSF), leupeptin, pepstatin, aprotinin,4-(2-aminoethyl)-benzenesulfonyl fluoride hydrochloride-bestatin,chymostatin, and benzamidine.

D. Hypertrophy Assay

A miniaturized assay is preferably used to assay the suspectedantagonist(s) for hypertrophy-inhibiting activity. In this assay themedium used allows the cells to survive at a low plating density withoutserum. By plating directly into this medium, washing steps areeliminated so that fewer cells are removed. The plating density isimportant: many fewer cells and the survival is reduced; many more cellsand the myocytes begin to self-induce hypertrophy.

The steps involved are:

(a) plating 96-well plates with a suspension of myocytes at a celldensity of about 7.5×10⁴ cells per mL in D-MEM/F-12 medium supplementedwith at least insulin, transferring and aprotinin;

(b) culturing the cells in the presence of LIF or endothelin;

(c) adding a substance to be assayed (the suspected antagonist of LIF orendothelin);

(d) culturing the cells with the substance; and

(e) measuring for hypertrophy.

The medium can be supplemented with additional elements such as EGF thatensure a longer viability of the cells, but such supplements are notessential. D-MEM/F-12 medium is available from Gibco BRL, Gaithersburg,Md., and consists of one of the following media:

    __________________________________________________________________________                11320                                                                              11321                                                                              11330                                                                              11331                                                                              12400                                                                              12500                                                1 × Liquid                                                                   1 × Liquid                                                                   1 × Liquid                                                                   1 × Liquid                                                                   Powder                                                                             Powder                                   Component   (mg/L)                                                                             (mg/L)                                                                             (mg/L)                                                                             (mg/L)                                                                             (mg/L)                                                                             (mg/L)                                   __________________________________________________________________________    AMINO ACIDS:                                                                  L-Alanine   4.45 4.45 4.45 4.45 4.45 4.45                                     L-Arginine.HCl                                                                            147.50                                                                             147.50                                                                             147.50                                                                             147.50                                                                             147.50                                                                             147.50                                   L-Asparagine.H.sub.2 O                                                                    7.50 7.50 7.50 7.50 7.50 7.50                                     L-Aspartic acid                                                                           6.65 6.65 6.65 6.65 6.65 6.65                                     L-Cysteine.HCl.H.sub.2 O                                                                  17.56                                                                              17.56                                                                              17.56                                                                              17.56                                                                              17.56                                                                              17.56                                    L-Cystine.2HCl                                                                            31.29                                                                              31.29                                                                              31.29                                                                              31.29                                                                              31.29                                                                              31.29                                    L-Glutamic acid                                                                           7.35 7.35 7.35 7.35 7.35 7.35                                     L-Glutamine 365.00                                                                             365.00                                                                             365.00                                                                             365.00                                                                             365.00                                                                             365.00                                   Glycine     18.75                                                                              18.75                                                                              18.75                                                                              18.75                                                                              18.75                                                                              18.75                                    L-Histidine.HCl.H.sub.2 O                                                                 31.48                                                                              31.48                                                                              31.48                                                                              31.48                                                                              31.48                                                                              31.48                                    L-Isoleucine                                                                              54.47                                                                              54.47                                                                              54.47                                                                              54.47                                                                              54.47                                                                              54.47                                    L-Leucine   59.05                                                                              59.05                                                                              59.05                                                                              59.05                                                                              59.05                                                                              59.05                                    L-Lysine.HCl                                                                              91.25                                                                              91.25                                                                              91.25                                                                              91.25                                                                              91.25                                                                              91.25                                    L-Methionine                                                                              17.24                                                                              17.24                                                                              17.24                                                                              17.24                                                                              17.24                                                                              17.24                                    L-Phenylalanine                                                                           35.48                                                                              35.48                                                                              35.48                                                                              35.48                                                                              35.48                                                                              35.48                                    L-Proline   17.25                                                                              17.25                                                                              17.25                                                                              17.25                                                                              17.25                                                                              17.25                                    L-Serine    26.25                                                                              26.25                                                                              26.25                                                                              26.25                                                                              26.25                                                                              26.25                                    L-Threonine 53.45                                                                              53.45                                                                              53.45                                                                              53.45                                                                              53.45                                                                              53.45                                    L-Tryptophan                                                                              9.02 9.02 9.02 9.02 9.02 9.02                                     L-Tyrosine 2Na 2H.sub.2 O                                                                 55.79                                                                              55.79                                                                              55.79                                                                              55.79                                                                              55.79                                                                              55.79                                    L-Valine    52.85                                                                              52.85                                                                              52.85                                                                              52.85                                                                              52.85                                                                              52.85                                    INORGANIC SALTS:                                                              CaCl.sub.2 anhyd.                                                                         116.60                                                                             116.60                                                                             116.60                                                                             116.60                                                                             116.60                                                                             116.60                                   CuSO.sub.4 5H.sub.2 O                                                                     0.0013                                                                             0.0013                                                                             0.0013                                                                             0.0013                                                                             0.0013                                                                             0.0013                                   Fe(NO.sub.3).sub.3 9H.sub.2 O                                                             0.05 0.05 0.05 0.05 0.05 0.05                                     FeSO.sub.4 7H.sub.2 O                                                                     0.417                                                                              0.417                                                                              0.417                                                                              0.417                                                                              0.417                                                                              0.417                                    KCl         311.80                                                                             311.80                                                                             311.80                                                                             311.80                                                                             311.80                                                                             311.80                                   MgCl.sub.2  28.64                                                                              28.64                                                                              28.64                                                                              28.64                                                                              28.64                                                                              28.64                                    MgSO.sub.4  48.84                                                                              48.84                                                                              48.84                                                                              48.84                                                                              48.84                                                                              48.84                                    NaCl        6999.50                                                                            6999.50                                                                            6999.50                                                                            6999.50                                                                            6999.50                                                                            6999.50                                  NaHCO.sub.3 2438.00                                                                            2438.00                                                                            2438.00                                                                            2438.00                                                                            --   --                                       NaH.sub.2 PO.sub.4 H.sub.2 O                                                              62.50                                                                              62.50                                                                              62.50                                                                              --   62.50                                                                              62.50                                    Na.sub.2 HPO.sub.4                                                                        71.02                                                                              71.02                                                                              71.02                                                                              --   71.02                                                                              71.02                                    ZnSO.sub.4 7H.sub.2 O                                                                     0.432                                                                              0.432                                                                              0.432                                                                              0.432                                                                              0.432                                                                              0.432                                    OTHER COMPONENTS:                                                             D-Glucose   3151.00                                                                            3151.00                                                                            3151.00                                                                            3151.00                                                                            3151.00                                                                            3151.00                                  HEPES       --   --   3574.50                                                                            3574.50                                                                            3574.50                                                                            --                                       Na hypoxanthine                                                                           2.39 2.39 2.39 2.39 2.39 2.39                                     Linoleic acid                                                                             0.042                                                                              0.042                                                                              0.042                                                                              0.042                                                                              0.042                                                                              0.042                                    Lipoic acid 0.105                                                                              0.105                                                                              0.105                                                                              0.105                                                                              0.105                                                                              0.105                                    Phenol red  8.10 8.10 8.10 8.10 8.10 8.10                                     Putrescine 2H.sub.2 O                                                                     0.081                                                                              0.081                                                                              0.081                                                                              0.081                                                                              0.081                                                                              0.081                                    Sodium pyruvate                                                                           55.00                                                                              55.00                                                                              55.00                                                                              55.00                                                                              55.00                                                                              55.00                                    VITAMINS:                                                                     Biotine     0.0035                                                                             0.0035                                                                             0.0035                                                                             0.0035                                                                             0.0035                                                                             0.0035                                   D-Ca pantothenate                                                                         2.24 2.24 2.24 2.24 2.24 2.24                                     Choline chloride                                                                          8.98 8.98 8.98 8.98 8.98 8.98                                     Folic acid  2.65 2.65 2.65 2.65 2.65 2.65                                     i-Inositol  12.60                                                                              12.60                                                                              12.60                                                                              12.60                                                                              12.60                                                                              12.60                                    Niacinamide 2.02 2.02 2.02 2.02 2.02 2.02                                     Pyridoxal HCl                                                                             2.00 --   2.00 --   2.00 2.00                                     Pyridoxine HCl                                                                            0.031                                                                              2.031                                                                              0.031                                                                              2.031                                                                              0.031                                                                              0.031                                    Riboflavin  0.219                                                                              0.219                                                                              0.219                                                                              0.219                                                                              0.219                                                                              0.219                                    Thiamine HCl                                                                              2.17 2.17 2.17 2.17 2.17 2.17                                     Thymidine   0.365                                                                              0.365                                                                              0.365                                                                              0.365                                                                              0.365                                                                              0.365                                    Vitamin B.sub.12                                                                          0.68 0.68 0.68 0.68 0.68 0.68                                     __________________________________________________________________________

The preferred hypertrophy assay comprises:

(a) pre-coating the wells of 96-well tissue culture plates with a mediumcontaining calf serum, preferably D-MEM/F-12 medium containing 4% fetalcalf serum, wherein preferably the wells are incubated with the mediumfor about eight hours at about 37° C.;

(b) removing the medium;

(c) plating a suspension of myocytes in the inner 60 wells at 7.5×10⁴cells per mL in D-MEM/F-12 medium supplemented with insulin,transferring and aprotinin;

(d) culturing the myocytes for at least 24 hours in the presence of LIFor endothelin;

(e) adding the test substance;

(f) culturing the cells with the test substance (preferably for about24-72 hours, more preferably for about 48 hours); and

(g) evaluating hypertrophy, preferably after crystal violet stain, bymicroscopic examination.

Preferably the medium used in step (c) is a serum-free medium alsocontaining penicillin/streptomycin (pen/strep) and glutamine. Mostpreferably, the medium contains 100 mL D-MEM/F-12, 100 μL transferring(10 mg/mL), 20 μL insulin (5 mg/mL), 50 μL aprotinin (2 mg/mL), 1 mLpen/strep (JRH Biosciences No. 59602-77P), and 1 mL L-glutamine (200mM).

Another method for assaying hypertrophy involves measuring for atrialnatriuretic peptide (ANP) release by means of an assay that determinesthe competition for binding of ¹²⁵ I-rat ANP for a rat ANP receptorA-IgG fusion protein. The method suitable for use is similar to thatused for determining GP130 using a CD4-IgG fusion protein described byChamow et al., Biochemistry, 29: 9885-9891 (1990).

2. Therapeutic Compositions and Administration of Antagonists

Antagonists to LIF alone or in combination with antagonists toendothelin are believed to find use as drugs for in vivo treatment ofmammals (e.g., animals or humans) experiencing heart failure, so as toprevent or lessen hypertrophic effects. For example, the LIF antagonistalone or with the endothelin antagonist may be useful in treatingcongestive heart failure in cases where ACE inhibitors cannot beemployed or are not as effective.

Therapeutic formulations of antagonist(s) for treating heart disordersare prepared for storage by mixing the antagonist(s) having the desireddegree of purity with optional physiologically acceptable carriers,excipients, or stabilizers (Remington's Pharmaceutical Sciences, 16thedition, Oslo, A., Ed., 1980!), in the form of lyophilized cake oraqueous solutions. Acceptable carriers, excipients, or stabilizers arenon-toxic to recipients at the dosages and concentrations employed, andinclude buffers such as phosphate, citrate, and other organic acids;antioxidants including ascorbic acid; low molecular weight (less thanabout 10 residues) polypeptides; proteins, such as serum albumin,gelatin, or immunoglobulins; hydrophilic polymers such aspolyvinylpyrrolidone; amino acids such as glycine, glutamine,asparagine, arginine or lysine; monosaccharides, disaccharides, andother carbohydrates including glucose, mannose, or dextrins; chelatingagents such as EDTA; sugar alcohols such as mannitol or sorbitol;salt-forming counterions such as sodium; and/or nonionic surfactantssuch as Tween, Pluronics, or polyethylene glycol (PEG). Theantagonist(s) are also suitably linked to one of a variety ofnonproteinaceous polymers, e.g., polyethylene glycol, polypropyleneglycol, or polyoxyalkylenes, in the manner set forth in U.S. Pat. Nos.4,640,835; 4,496,689; 4,301,144; 4,670,417; 4,791,192 or 4,179,337.

The antagonist(s) to be used for in vivo administration must be sterile.This is readily accomplished by filtration through sterile filtrationmembranes, prior to or following lyophilization and reconstitution. Theantagonist(s) ordinarily will be stored in lyophilized form or insolution.

Therapeutic antagonist compositions generally are placed into acontainer having a sterile access port, for example, an intravenoussolution bag or vial having a stopper pierceable by a hypodermicinjection needle.

The antagonist(s) administration is in a chronic fashion using, forexample, one of the following routes: injection or infusion byintravenous, intraperitoneal, intracerebral, intramuscular, intraocular,intraarterial, or intralesional routes, orally if an orally active smallmolecule is employed, or using sustained-release systems as noted below.Antagonist (s) is administered continuously by infusion or by periodicbolus injection if the clearance rate is sufficiently slow, or byadministration into the blood stream or lymph. The preferredadministration mode is directly to the heart, so as to direct themolecule to the source and minimize side effects of the antagonists.

Suitable examples of sustained-release preparations includesemipermeable matrices of solid hydrophobic polymers containing theprotein, which matrices are in the form of shaped articles, e.g., films,or microcapsules. Examples of sustained-release matrices includepolyesters, hydrogels (e.g., poly(2-hydroxyethyl-methacrylate)asdescribed by Langer et al., J. Biomed. Mater. Res., 15: 167-277 1981!and Langer, Chem. Tech., 12: 98-105 1982! or poly(vinylalcohol)),polylactides (U.S. Pat. No. 3,773,919, EP 58,481), copolymers ofL-glutamic acid and gamma ethyl-L-glutamate (Sidman et al., Biopolymers,22: 547-556 1983!), non-degradable ethylene-vinyl acetate (Langer etal., supra), degradable lactic acid-glycolic acid copolymers such as theLupron Depot™ (injectable microspheres composed of lactic acid-glycolicacid copolymer and leuprolide acetate), and poly-D-(-)-3-hydroxybutyricacid (EP 133,988). The antagonist(s) also may be entrapped inmicrocapsules prepared, for example, by coacervation techniques or byinterfacial polymerization (for example, hydroxymethylcellulose orgelatin-microcapsules and poly- methylmethacylate! microcapsules,respectively), in colloidal drug delivery systems (for example,liposomes, albumin microspheres, microemulsions, nano-particles andnanocapsules), or in macroemulsions. Such techniques are disclosed inRemington's Pharmaceutical Sciences, supra.

While polymers such as ethylene-vinyl acetate and lactic acid-glycolicacid enable release of molecules for over 100 days, certain hydrogelsrelease proteins for shorter time periods. When encapsulated proteinsremain in the body for a long time, they may denature or aggregate as aresult of exposure to moisture at 37° C., resulting in a loss ofbiological activity and possible changes in immunogenicity. Rationalstrategies can be devised for protein stabilization depending on themechanism involved. For example, if the aggregation mechanism isdiscovered to be intermolecular S--S bond formation throughthio-disulfide interchange, stabilization may be achieved by modifyingsulfhydryl residues, lyophilizing from acidic solutions, controllingmoisture content, using appropriate additives, and developing specificpolymer matrix compositions.

Sustained-release antagonist(s) compositions also include liposomallyentrapped antagonist(s). Liposomes containing antagonist(s) are preparedby methods known per se: DE 3,218,121; Epstein et al., Proc. Natl. Acad.Sci. USA, 82: 3688-3692 (1985); Hwang et al., Proc. Natl. Acad. Sci.USA, 77: 4030-4034 (1980); EP 52,322; EP 36,676; EP 88,046; EP 143,949;EP 142,641; Japanese patent application 83-118008; U.S. Pat. Nos.4,485,045 and 4,544,545; and EP 102,324. Ordinarily the liposomes are ofthe small (about 200-800 Angstroms) unilamellar type in which the lipidcontent is greater than about 30 mol. % cholesterol, the selectedproportion being adjusted for the optimal antagonist therapy. A specificexample of a suitable sustained-release formulation is in EP 647,449.

An effective amount of antagonist(s) to be employed therapeutically willdepend, for example, upon the therapeutic objectives, the route ofadministration, and the condition of the patient. Accordingly, it willbe necessary for the therapist to titer the dosage and modify the routeof administration as required to obtain the optimal therapeutic effect.A typical daily dosage of LIF antagonist used alone might range fromabout 1 μg/kg to up to 100 mg/kg of patient body weight or more per day,depending on the factors mentioned above, preferably about 10 μg/kg/dayto 10 mg/kg/day.

If the two antagonists are administered together, they need not beadministered by the same route, nor in the same formulation. However,they can be combined into one formulation as desired. Both antagonistscan be administered to the patient, each in effective amounts, or eachin amounts that are sub-optimal but when combined are effective.Preferably such amounts are about 10 μg/kg/day to 10 mg/kg/day of each.In another preferred embodiment, the administration of both antagonistsis by injection using, e.g., intravenous or subcutaneous means,depending on the type of antagonist employed. Typically, the clinicianwill administer the antagonist(s) until a dosage is reached thatachieves the desired effect for treatment of the heart dysfunction. Forexample, the amount would be one which decreases hypertrophy, increasesventricular contractility, and decreases peripheral vascular resistanceor ameliorates or treats conditions of similar importance in congestiveheart failure patients, thus obtaining the result desired in thecontinuum of equilibria between growing and shrinking of cardiac muscletissue. The progress of this therapy is easily monitored by conventionalassays.

The two types of antagonists, if used together, may be formulatedtogether in an appropriate carrier vehicle to form a pharmaceuticalcomposition that preferably does not contain cells. In one embodiment,the buffer used for formulation will depend on whether the compositionwill be employed immediately upon mixing or stored for later use, sincelong-term storage may bring into issue stability such as solubility andaggregation that can be addressed by altering the pH. The finalpreparation may be a stable liquid or lyophilized solid.

The antagonist(s) optionally is combined with or administered in concertwith other agents for treating congestive heart failure, including ACEinhibitors, CT-1 inhibitors, hGH, and/or IGF-I.

The effective amounts of such agents, if employed, will be at thephysician's or veterinarian's discretion. Dosage administration andadjustment is done to achieve the best management of congestive heartfailure and ideally takes into account use of diuretics or digitalis,and conditions such as hypotension and renal impairment. The dose willadditionally depend on such factors as the type of drug used and thespecific patient being treated. Typically the amount employed will bethe same dose as that used if the drug were to be administered withoutantagonist; however, lower doses may be employed depending on suchfactors as the presence of side-effects, the condition being treated,the type of patient, and the type of antagonist and drug, provided thetotal amount of agents provides an effective dose for the conditionbeing treated.

Thus, for example, in the case of ACE inhibitors, a test dose ofenalapril is 5 mg, which is then ramped up to 10-20 mg per day, once aday, as the patient tolerates it. As another example, captopril isinitially administered orally to human patients in a test dose of 6.25mg and the dose is then escalated, as the patient tolerates it, to 25 mgtwice per day (BID) or three times per day (TID) and may be titrated to50 mg BID or TID. Tolerance level is estimated by determining whetherdecrease in blood pressure is accompanied by signs of hypotension. Ifindicated, the dose may be increased up to 100 mg BID or TID. Captoprilis produced for administration as the active ingredient, in combinationwith hydrochlorothiazide, and as a pH stabilized core having an entericor delayed release coating which protects captopril until it reaches thecolon. Captopril is available for administration in tablet or capsuleform. A discussion of the dosage, administration, indications andcontraindications associated with captopril and other ACE inhibitors canbe found in the Physicians Desk Reference, Medical Economics DataProduction Co., Montvale, N.J. 2314-2320 (1994).

The following examples are offered by way of illustration and not by wayof limitation. The disclosures of all citations in the specification areexpressly incorporated herein by reference.

EXAMPLE I

1. Materials and Methods

A. Materials

The collagenase CLS 2 was from Worthington (Freehold N.J.) and thePercoll™ from Pharmacia Biotech AB (Uppsala, Sweden). The culture mediaand supplements were from GIBCO BRL (Grand Island, N.Y.). The aprotininand crystal violet were from Sigma, St. Louis, Mo. The crystallizedbovine serum albumin (BSA) was from ICN Biomedicals (Aurora, Ill.). TheFalcon 96 well plates were from Becton Dickenson (Oxnard, Calif.) andthe Lab Tek™ chamber slides from Nunc (Naperville, Ill.). Human/porcineendothelin-1 was from American Peptides (Sunnyvale, Calif.). Mouse andhuman LIF have been recombinantly produced. See Rose and Todaro, WO93/05169 and Kim et al., supra. The recombinant murine LIF used hereinwas from Genzyme, Mass; the anti-human LIF monoclonal antibodies wereobtained as described by Kim et al., supra, and WO 93/23556, supra. TheBQ-123 was obtained as described by Ihara et al., Life Science, supra;JP 51-94254A, supra; Webb et al., supra); and the ANP and theANP-receptor IgG fusion protein were obtained as described by Chamow etal., supra.

B. Myocyte Culture and Hypertrophy Assay

Neonatal rat cardiac ventricular myocytes were cultured in 96- wellplates as described by Pennica et al., supra. Briefly, myocytes wereisolated from one-day-old Sprague-Dawley rats by a series of collagenasedigestions followed by Percoll™ gradient purification. Iwaki et al., JBiol Chem., 265: 13809-13817 (1990). The myocytes, which band at thelower gradient interface, were collected, washed twice, and re-suspendedin D-MEM/F12 medium with 15% (vol/vol) fetal calf serum. The cells werediluted into serum-free D-MEM/F12 medium supplemented with 10 μg/mLtransferring, 1 μg/mL insulin, 1 μg/mL aprotinin, 2-mmol/L glutamine,100 U/mL penicillin G, and 100 μg/mL streptomycin (assay medium) to afinal density of 7.5×10⁴ cells per mL. The final serum concentration ofthis assay medium with cells was<0.1%. Myocytes were plated 200 μL perwell in 96-well, flat-bottomed plates that had previously been coatedwith D-MEM/F12 medium with 4% (vol/vol) fetal calf serum for 8 hours at37° C. After 24 hours at 37° C. in 5% CO₂, test substances were added.Forty-eight hours after the test substances were added, the cells werefixed and stained with 0.5% (wt/vol) crystal violet in methanol andformaldehyde, and the hypertrophy was scored on a scale of 1 to 7 bymicroscopic evaluation. Untreated cells were used as the negativecontrol and scored as a 3. Toxic effects were scored from 0 to 2. Thepositive control in each assay was 100 μmol/L phenylephrine, which wasscored as 7.

C. Non-myocyte Culture

The band at the upper gradient interface is enriched for non-myocytes inthe procedure described above. They were collected, washed twice, andre-suspended in D-MEM/F12 medium with 10% fetal calf serum (30 mL/50hearts) and plated in T75 flasks (2/50 hearts). After one hour at 37° C.in 5% CO2, the flasks were gently swirled and the medium was replaced.After 4 days in culture the cells were trypsinized and re-plated at4×10⁵ cells per mL in T25 flasks (5 mL/flask). Almost all of thecontaminating myocytes are destroyed by this procedure. After 5 days inculture, the cells were washed twice in serum-free D-MEM/F12 medium, andconditioning medium (assay medium with 1 mg/mL BSA) was added. Theconditioned medium was removed after 24 hours, centrifuged to removecells and debris, and stored at 4° C.

D. ANP Measurements

Rat ANP concentrations were determined by competition for the binding ofrat ¹²⁵ I-ANP for a rat ANP receptor A-IgG fusion protein. Chamow etal., supra.

E. Endothelin Measurements

Endothelin concentrations were determined with the Amersham Endothelin1,2 (high sensitivity) assay system (Amersham, Arlington Heights, Ill.).

F. LIF Measurements

The LIF sandwich ELISA was performed as described by Kim et al., supra,with the following modifications. After the microtiter plates werecoated overnight with Mab D4.16.9 (to human LIF), blocked with 0.5%(wt/vol) BSA and washed, the murine LIF standards and samples were addedand the plates incubated for 2 hours at room temperature. Thenbiotinylated (with Pierce ImmunoPur™ Sulfo-NHS-Biotin™) Mab D62.3.2 (tohuman LIF) was added and the plates were incubated at room temperaturefor 1 hour. The plates were washed, streptavidin-peroxidase conjugate(Boehringer-Mannheim Biochemicals, Indianapolis, Ind.) was added, andthe plates were incubated for 30 minutes at room temperature. The plateswere washed and the peroxidase substrate TMB (tetramethylbenzidine)(Kirkegaard and Perry, Gaithersburg Md.) was added. Color developmentwas stopped after 10 minutes by the addition of H3PO4. The absorbance at450 nm was determined using a microtiter plate reader. An estimate ofthe concentration of the rat LIF in the NCM was determined by comparisonto a murine LIF standard curve.

G. Immunocytochemistry;

The myocytes were plated in 4-chamber Lab Tek™ glass chamber slidespre-costed for 8 hours with 4% (vol/vol) fetal calf serum in D-MEM/F12medium and cultured for 24 hours. They were exposed to test substancesfor 48 hours and then washed 3× in phosphate buffered saline (PBS) andfixed in 95% (vol/vol) ethanol for 15 minutes. The slides were thenwashed 3× in PBS with 0.1% (vol/vol) Tween-20™ surfactant, blocked for30 minutes with it (wt/vol) BSA in PBS with 0.1% Tween-20™ surfactant,and incubated with phallacidin conjugated to BODIPY FL™ brand reagent(10 μg/mL in 1% BSA in PBS) (Molecular Probes, Eugene Oreg.) for 40minutes to stain the f-actin present in the contractile fibers. Theslides were then washed 3× with PBS in 0.1% Tween-20™ surfactant. Imagesof the phallacidin-stained cells were acquired on a Ultima™ laser-scanning confocal microscope (Meridian Instruments, Okemos, Mich.). A1.4 NA 60X ™ oil-immersion objective was utilized coupled with 488-nmexcitation, with the resulting fluorescence measured following a 525-nmlong-pass filter. Data were collected at a horizontal and verticalresolution of 0.2 μm and a z-resolution of 0.5 μm. Each data point wascollected as an average of 200 measurements. The final images wereconstructed with a maximum fluorescence projection algorithm bycompressing the multiple z or depth images into a single two-dimensionalrepresentation.

The non-myocytes were plated in 4-chamber Lab Tek™ glass chamber slides,cultured for 5 days, washed 3× with PBS and fixed in 95% ethanol for 15minutes. The slides were washed 3× in PBS, blocked for 30 minutes with1% BSA in PBS with 0.1% (vol/vol) Triton X-100™ surfactant, andincubated with the following primary antibodies for 2 hours: (1)monoclonal anti-tropomysin (sarcomeric) (Sigma, St. Louis, Mo.) 1:50 tostain for myocytes, (2) monoclonal anti-alpha smooth muscle actin(Sigma) 1:2500 to stain for fibroblast-like cells, and (3) rabbitanti-human Von Willebrandt Factor (DAKO, Carpenteria, Calif.) 1:500 tostain for endothelial cells. After 3 washes with PBS, the slides wereincubated with the appropriate fluorescein-conjugated secondaryantibodies (Sigma) 1:200 for 45 minutes and washed 3× with PBS.

2. Results

A. Production of Hypertrophy Activity by Cultured Cardiac Non-myocytes

After exposure to 50% (vol/vol) NCM for 48 hours, neonatal ratventricular myocytes became enlarged (hypertrophy score 7) compared tountreated cells (hypertrophy score 3), with increased organization ofcontractile fibers. The increase in myocyte cell size, expressed ashypertrophy score, is dose dependent (FIG. 1A) and is accompanied by anincrease in ANP production (FIG. 1B). The hypertrophic activity in theNCM accumulates rapidly up to 5 hours and peaks by 24 hours (FIG. 2). Aseeding density of 0.2 to 0.4 million cells per mL is necessary formaximal activity.

B. Inhibition of Non-myocyte Conditioned Medium Hypertrophy Activity byEndothelin Receptor Blocker and LIF Monoclonal Antibody

The endothelin A receptor blocker BQ-123 and a Mab to recombinant humanLIF (Mab D62.3.2) each partially inhibited the NCM hypertrophy activity.When both were added together, the activity was almost completelyblocked (FIG. 3). The BQ-123 and the LIF Mab appeared to be specificinhibitors. BQ-123 blocked only the hypertrophy activity induced byendothelin-1, not CT-1, mouse LIF (MLIF), or phenylephrine (FIG. 4). TheLIF Mab was partially neutralizing for the activity induced by mLIF anddid not affect the activity induced by endothelin-1, CT-1 orphenylephrine (FIG. 5). BQ-123 and the LIF Mab by themselves had noeffect on myocyte morphology.

The presence of endothelin and LIF in the NCM was confirmed byimmunoassay. Endothelin (endothelin-1and -2 and big endothelin) in NCMwas measured by radioimmunoassay and averaged 229±10 pmol/L for threepreparations. The concentration of LIF in the NCM was estimated using asandwich ELISA with two anti-human LIF monoclonal antibodies and mouseLIF as the standard. The value obtained for the concentration of LIFusing this technique was 190±50 pmol/L for three preparations.

C. Effect of Purified LIF and Endothelin on Cardiac Myocyte Hypertrophyin vitro

The typical morphology of the myocytes after a 48-hour exposure tomaximal concentrations of purified mLIF and endothelin-1 alone and thecombination of the two agents was observed. The cells exposed to LIFtended to be stretched with dendritic-like processes. Those exposed toendothelin were more compact with no processes. Exposure to thecombination resulted in a hybrid phenotype with a loss of processes andan increase in size that resembles the morphology resulting fromtreatment with phenylephrine and NCM.

The organization of the contractile fibers was observed for myocyteswhich had been stained with fluorescent phallacidin to visualizef-actin. The fibers in the non-treated controls were disorganized andshort compared to those in the myocytes, which had hypertrophied. Thefibers in the endothelin-treated cells were not organized in parallel,had a tangled appearance, and did not show prominent banding. The fibersin the myocytes treated with mLIF, the combination of mLIF andendothelin, and phenylephrine were organized in parallel arrays withprominent banding showing the sarcomeric units. In the mLIF-treatedcells the contractile fibers were seen to extend to the tips of theprojections. The results in FIG. 6 indicate that LIF and endothelin wereadditive with respect to ANP production (FIG. 6A), and with respect tocell size, expressed as hypertrophy score (FIG. 6B).

D. Identity of Non-myocytes

Immunocytochemistry studies showed that the majority of the culturedcardiac non-myocytes stained with antibody to smooth muscle actin in astress fiber pattern. Alpha smooth muscle actin expression was observedin cultured fibroblasts derived from newborn rat cardiac tissue.Brouty-Boye et al., In Vitro Cell Dev. Biol., 28A: 293-296 (1992). Themyocytes in their study also expressed this actin isoform and could bedistinguished from the fibroblasts by the pattern of staining: stressfiber for fibroblasts vs. a striated pattern for myocytes. A similarstress fiber staining pattern was reported by Long et al., supra, intheir study of cardiac non-myocytes. Less than 1% of the non-myocyteswere found to be endothelial cells (with an antibody to Von WillebrandtFactor) and myocytes (with an antibody to sarcomeric tropomysin). Therewas no staining on slides where the primary antibodies had been omitted.

The reagents used in this example to block the endothelin and LIFhypertrophic activity appeared to be specific. BQ-123 blocked only thehypertrophic activity induced by endothelin-1, not CT-1, mouse LIF, orphenylephrine. The radioimmunoassay for endothelin, which measuresendothelin-1 and -2 and big endothelin, confirmed the receptor blockerdata for the presence of endothelin in the NCM.

The LIF monoclonal antibody used in this example, generated againstrecombinant human LIF, showed neutralizing activity against thehypertrophy induced by both human and mouse LIF, but not against CT-1-,endothelin-, or phenylephrine-induced hypertrophy. Four monoclonalantibodies were available (Mabs D3.14.1, D4.16.9, D25.1.4, and D62.3.2;deposited with the American Type Culture Collection, 12301 ParklawnDrive, Rockville, Md., on Jun. 23. 1992 and assigned ATCC AccessionNumbers HB 11076, HB 11077, HB 11074, and HB 11075, respectively), eachof which recognized a different epitope on recombinant human LIF. Threeof these (Mabs D4.16.9, D25.1.4, and D62.3.2) neutralized the myocytehypertrophy induced by mouse and human LIF, and two (Mabs D25.1.4 andD62.3.2) were equipotent in inhibiting the hypertrophy induced by NCM.Mab D3.14.1 did not neutralize the ability of mouse or human LIF toinduce myocyte hypertrophy. An approximation of the rat LIFconcentration in NCM was made using a sandwich ELISA with two of themonoclonal antibodies which neutralized mouse and human LIF-inducedhypertrophic activity and with mouse LIF as a standard. The amino acidsequence of rat LIF is 92% similar to mouse LIF. Gough et al., GrowthFactors, 7: 175-179 (1992).

In this culture system neither purified LIF nor endothelin alone couldinduce a maximal hypertrophic response with respect to both myocyte cellsize and ANP production, even at nanomolar concentrations. Furthermore,each agent induced a characteristic morphology which was different fromthat induced by phenylephrine. When LIF and endothelin were combined,however, a maximal hypertrophy was induced in the myocytes whichresembled those treated with NCM in cell size, morphology, andcontractile fiber organization. The myocytes treated with NCM and BQ-123resembled those treated with purified LIF, as would be expected if theendothelin activity were blocked. The myocytes treated with NCM and theLIF Mab resembled those treated with purified endothelin-l, as would beexpected if the LIF activity were blocked.

The responses induced by LIF and endothelin were additive with respectto both cell size and ANP formation.

Immunofluorescence studies indicate that the non-myocyte cultures inthis example contained primarily fibroblast-like cells (which stain withantibodies to smooth muscle actin) with less than 1% endothelial cellsand myocytes.

In summary, LIF and endothelin were identified as the factors incultured cardiac neonatal rat NCM that are responsible for the majorityof its hypertrophic activity on cultured cardiac neonatal rat myocytes.The presence of endothelin and LIF was confirmed by immunoassay andfound to be in the range of 200 pmol/L. Purified LIF and endothelininduced partial hypertrophic responses with morphologies characteristicfor each molecule, and neither factor alone promoted the maximalhypertrophic response seen with the combination. The response to thecombination of both agents appeared to be additive with respect tomyocyte size, morphology, ANP production, and organization ofcontractile fibers.

What is claimed is:
 1. A method for treating a mammal experiencing heartfailure to prevent or lessen hypertrophy comprising administeringchronically to a mammal in need of such treatment a therapeuticallyeffective amount of a leukemia inhibitory factor antagonist antibody,wherein the antagonist antibody binds LIF and blocks or preventsinteraction between LIF and its cellular receptor.
 2. The method ofclaim 1 wherein the mammal is a human and the antagonist is a humanantibody or a humanized antibody.
 3. The method of claim 2 wherein theantibody is a monoclonal antibody.
 4. The method of claim 1, wherein theLIF binds to a LIF binding region from a monoclonal antibody selectedfrom the group consisting of ATCC HB 11077, HB 11074, and HB 11075.